Difficulty: Medium
Average Score: 63%
Simulated
A nurse is assessing a preschool-age child who is in the immediate postoperative period following a tonsillectomy. Which of the following assessment findings is the priority?
Correct answer
D
Rationale
The correct answer is D: The child swallows frequently. This is the priority assessment finding because it could indicate postoperative bleeding, a serious complication after a tonsillectomy. Frequent swallowing may suggest blood pooling in the throat. Prompt intervention is crucial to prevent further bleeding and ensure the child's safety.
Incorrect Choices:
A: The child's throat pain increases - Important but not the priority as it is expected post-tonsillectomy.
B: The child refuses clear liquids - Not the priority unless it persists and leads to dehydration.
C: The child cries often - Common after surgery but not indicative of a serious complication like bleeding.
Incorrect Choices:
A: The child's throat pain increases - Important but not the priority as it is expected post-tonsillectomy.
B: The child refuses clear liquids - Not the priority unless it persists and leads to dehydration.
C: The child cries often - Common after surgery but not indicative of a serious complication like bleeding.